Getting back in rhythm

A minimally invasive procedure assists a Kailua man with an irregular heartbeat

Carol Caspillo said she prodded her husband, Ray, "to hurry up and get better" before the plants died.

The 68-year-old man became ill last year with an abnormal heartbeat and couldn't care for them. "He would try but the plants failed with him," she said.

"You should see it now," the Kailua woman added in a recent interview. "Everything's in bloom -- anthuriums and orchids."

Caspillo's strength returned after an innovative, minimally invasive procedure last August at Hawaii Medical Center-East. It was done by Dr. Jeffrey Lee, medical director of the hospital's new Atrial Fibrillation Center.

Atrial fibrillation, an abnormal heart rhythm, originates from pulmonary veins draining from the lungs into the heart, Lee said. To stop it, "we need to electrically isolate pulmonary veins from the heart," he said.

The technique he is using was originally developed in the 1980s by renowned cardiologist James Cox, now medical director of ATS Medical Inc., a cardiac surgery product manufacturer. However, Cox's method required open-heart surgery, Lee said.

Lee's team has pioneered the procedure for Hawaii patients with no cutting involved, he said. "We do it from outside in. You can imagine how much more effective it is."

They make three small incisions, less than 1 inch, on the chest. Then they use advanced endoscopic techniques to insert a flexible catheter and wrap it around the beating heart.

An electrical scar creates a wall to stop the irregular heartbeat from trying to reach the heart by the pulmonary veins, Lee said. The procedure takes about two hours, and patients usually can go home the next morning.

CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM
Carol and Ray Caspillo are happy that Ray is healthy again and that their garden is flourishing.

Some mainland cardiothoracic surgeons have been observing them to learn the technique.

Dr. Vib Kshettry, Minneapolis cardiothoracic surgeon, and Dr. Tea Acuff, cardiothoracic surgeon at three Texas medical centers, were impressed with what they saw.

"Procedures like they're doing in Hawaii will be a model," Kshettry said, noting physicians have "shied away from surgery" for atrial fibrillation.

Acuff said most doctors think all they have to do to treat abnormal heart rhythm is give the patient medicine. "In the past there was not much good therapy to treat it with," Acuff said.

But Kshettry said some studies have shown the effectiveness of controlling symptoms with medicine is less than 10 percent.

Some patients have no symptoms, but 10 percent to 25 percent have serious complications, the doctors said. They can include poor blood flow, heart palpitations, shortness of breath and weakness. Atrial fibrillation also is a leading cause of stroke.

Ray Caspillo's heartbeat was "up and down," he said. "I had it off and on" and did not know why, which "was the scary part," he added.

He went to Castle Medical Center's emergency room in June because he was not feeling well and was hospitalized for three or four days, he said.

He was off work from Aloha Termite Co. for three months, had surgery Aug. 17, and he is "excellent" now, he said. He is pain-free, walking for exercise and back to growing beautiful flowers.

"It's definitely a big difference," his wife said.

Lee said his technique is 83 percent effective, versus about 50 percent for ablation methods that involve inserting a catheter into the heart to destroy tissue interfering with the heart's normal electrical impulses.